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I need a 2nd opinion on this case

  1. Default I need a 2nd opinion on this case
    Medical Coding Books
    Hello Coders,

    Please check this and tell me if I am correct or I am loosing my mind

    Ptn Present in OB/Gyn office w/ c/o "I'm bleeding" Ptn has IUD copper T/ aslo Vag Discharge w/ odor.

    Doctor does full check up, IUD Surv (Transvag sono, Pap/Hpv/GC/CT and Breast/Pelvic Exam
    RX for metro-Gel/Clindesse/ DDiflucan/ Ibuprofin

    I bill 99215-25 with 626.2, 616.10, v25.42
    76830 with 626.2, 616.10, v25.42
    Q0091 with v76.2 (last Pap done in 2008)(10 months ago)
    G0101 with v76.19

    INS.: Pays for 76830 and G0101
    Denies 99215-25 as incidental to G0101 AND
    Denies Q0091 as Not a payable code.

    Now this ins company never pays for Q0091 which we w/off BUT
    Denial on 99215 as incidenal to Breast exam when primary DX are Menorrhagia, BV and IUD check up is a bit much I though.

    Can you please look this over and let me know what you guys think?

    THANKS ALOT!!!

  2. #2
    Default 2nd opinion
    Quote Originally Posted by dan528i View Post
    Hello Coders,

    Please check this and tell me if I am correct or I am loosing my mind

    Ptn Present in OB/Gyn office w/ c/o "I'm bleeding" Ptn has IUD copper T/ aslo Vag Discharge w/ odor.

    Doctor does full check up, IUD Surv (Transvag sono, Pap/Hpv/GC/CT and Breast/Pelvic Exam
    RX for metro-Gel/Clindesse/ DDiflucan/ Ibuprofin

    I bill 99215-25 with 626.2, 616.10, v25.42
    76830 with 626.2, 616.10, v25.42
    Q0091 with v76.2 (last Pap done in 2008)(10 months ago)
    G0101 with v76.19

    INS.: Pays for 76830 and G0101
    Denies 99215-25 as incidental to G0101 AND
    Denies Q0091 as Not a payable code.

    Now this ins company never pays for Q0091 which we w/off BUT
    Denial on 99215 as incidenal to Breast exam when primary DX are Menorrhagia, BV and IUD check up is a bit much I though.

    Can you please look this over and let me know what you guys think?

    THANKS ALOT!!!
    Is the patient a medicare patient? I only use the G and Q codes for medicare and consider the pap inclusive to the E/M for all others. So, if this were me, I would have billed the 99215-25 and the 76830.

    Anyone else?

  3. Default
    Its NOT a medicare ptn but most of ins comp in NY pay for G and Q codes (I think it depends on provider contract). In this case it was actually Oxford which by the way never paid neither Q nor G but this time they paid G0101 and denied E&M.

  4. #4
    Default
    I'm having a hard time with the 99215 plus screening codes.

    It sounds to me like this ended up being more of a yearly exam, since you used the words "check up" than the highest level problem visit.

    If you can truly support a 99215, I would think breast exam would be included in that, same thing with a pap collection.

    Just my opinion,

    Laura, CPC

  5. #5
    Default 2nd opinion
    I have to agree with you, I posted and then questioned the 99215 myself. We have providers here who believe they should code the 99215 instead of the preventive visits. We're having a hard time getting them to conform, but we're working on it.

  6. Default
    Quote Originally Posted by katmryn78 View Post
    I'm having a hard time with the 99215 plus screening codes.

    It sounds to me like this ended up being more of a yearly exam, since you used the words "check up" than the highest level problem visit.

    If you can truly support a 99215, I would think breast exam would be included in that, same thing with a pap collection.

    Just my opinion,

    Laura, CPC

    OK but why would the breast exam and PAP be included? Ptn present w/ c/o vaginal bleeding.

  7. #7
    Default
    How are you supporting the 99215?

    I don't see how you would get high complexity mdm ( I could be wrong though), so I am assuming you are supporting it with comprehensive history and exam, which should include the exam elements for breast and vagina in this patient.

    Just my take,

    Laura, CPC

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